By Tom Geoghegan
BBC News Magazine
A new play which suggests therapy may increase dependency has reignited the debate about whether it makes people more needy. As more Britons than ever before seek counselling, many are in two minds about talking over their feelings.
Forget the famous British stiff upper lip - more people are opening up to talk through their problems with a professional.
The number of qualified counsellors has tripled in 10 years to keep up with rising demand. And January is the peak period for sessions as people reassess their lifestyles, according to charity Drugscope.
A society becoming more mobile, detached, stressed and divorce-ridden is blamed for the rush to the couch, underlined and encouraged by celebrities such as Robbie Williams speaking openly about their therapy.
Although widely held as a cause for celebration that the British are no longer bottling up their problems, there is scepticism in some quarters.
Therapy can become an addiction in itself, says Alice Kahrmann, 23, who has written a loosely biographical play called Powerless, which opens on Friday in London. It tells the story of two people who try to break free from the rigours of treatment.
Ms Kahrmann had an eating disorder for five years and went on a 12-Step treatment programme, an approach popular all over the world with groups such as Alcoholics Anonymous. But she says she merely substituted one addiction for another.
"The way the programme works isn't about empowering the individual but becoming dependent on the group," she says. "The mentality is that once an addict, always an addict and a 'separation' develops with normal people because drinking and drugs makes them dangerous. You're told that once you will leave, you will relapse."
Fear on leaving
She says the system worked really well for people with drug and alcohol dependency but not for her, because talking about food, weight and image incessantly meant she was living the identity of someone with an eating disorder.
Depression was the root cause of the problem, she says, and she left the programme after six months to seek help - a move which initially struck her with fear. But she tried alternative treatment called neurofeedback and has felt better since.
WHO TO TURN TO?
Psychiatrist: A qualified medical doctor who then specializes in the broad field of mental health, can prescribe medicine, commonly deals with depression, schizophrenia
Psychologist: Clinical and counselling psychologists offer individual therapy for conditions such as eating disorders, substance abuse, phobias and low self-esteem
Counsellor/Psychotherapist: Umbrella term for practitioners of 'the talking therapies' including marriage, family and sex therapists. Accreditation requires rigorous training and supervision
Psychoanalyst: originally inspired by the works of Freud and Jung, deals with 'making the unconscious conscious' eg. neurosis
Life coach: Helps people set and achieve personal goals
An Alcoholics Anonymous spokeswoman said the 12-Step Fellowship was designed 70 years ago for people with drink problems and had been successful in "repairing the damage of the past" for thousands of people.
But Ms Kahrmann's experience is not uncommon for people undergoing counselling or psychotherapy, claims sociologist Frank Furedi.
"Therapy does increase dependency," he says. "It distracts people from dealing with their problems and makes them estranged from their friends and lovers."
Counsellors are shaping people's lives, he argues, because "you find you are doing things according to a script written by someone else".
"A lot of people say it works for them but what they mean is they are being listened to and taken seriously by someone. Their problems remain and they go from one therapy to another, on a lifelong quest."
He fears the rise in the number of counsellors - and more recently "life coaches"- is creating a needy society encouraged by an Oprah Winfrey culture.
Nonsense, that's just nostalgia for the repressed 1950s, says Phillip Hodson of the British Association of Counselling and Psychotherapy, who is delighted more and more people are talking about their feelings.
"Britain's stiff upper lip has wobbled, if not on occasion broken down," he says, since the public grief of Princess Diana's death.
Counselling has spread because organisations have found it to be an extremely successful and cost-effective solution, he says. It can reduce rates of sickness and absence by half.
Even butch men are using the couch
"Life has changed since we became a rich country. It isn't about a struggle to survive but we may well be troubled by the meaning of life and where it's going. These are marginal areas of relative pain.
"So in the absence of an overwhelming theology or a paternal family, we look for therapy to help us in a supportive and questioning role. It doesn't just deal with problems, but existential philosophy as well - the meaning of life."
He says 12 Steps does not constitute proper therapy, - although it has "saved the lives" of countless drug and alcohol addicts - because it tackles the effect, not the root cause.
"Therapy is being able to tell a story of your own life and the feelings you've been hiding, so you can address them, put them away and free up your behaviour."
No jargon, please
He concedes there needs to be more regulation of practitioners and is critical of the notion professionals can take away pain or heal the soul.
But he scotches the theory that counsellors encourage dependence. "The goal of a therapist is to get rid of his clients."
Good therapy makes the client more "autonomous and self-determined", says the UK Council of Psychotherapists.
"The individual should be able to find their way around the various types of therapy available supported by simple 'jargon-free' signposting," says a spokeswoman. "The therapist should be supportive, effective, responsive to their needs, safe to practice and accountable."
Powerless runs at Barons Court Theatre in London until 23 January
Here are some of your comments. Thanks for contributing to the debate.
Whether or not a person becomes addicted to counselling may depend on the skills and training of the counsellor. I'm currently in therapy after the dramatic break-up of my marriage. Therapy has helped me regain my life and I had to dig deep into my inner strength. My therapist has helped me to explore myself and to grow stronger. I'm not dependant on my therapist but rather I see it as a fast track route to healing.
Mohammed, United Arab Emirates
Having spent some time in a 12-step programme myself, I can say that I did become co-dependant on the group. To question the philosophy was frowned upon. Fear of relapse was used by the group collective to prevent people from leaving. I have no doubt that such groups have a lot in common with other cults, having experienced being in one as a child. I managed to extracate myself from the 12-step fellowship, got myself into therapy and far from being dependent, I have for now finished therapy. I have dealt with the causes of my problems and not just the symptoms. If I need therapy again, it is there. I don't carry the shame anymore I used to. Indeed my life is better than it has ever been. Therapy has been the best thing I have ever done. I now feel at peace with myself and am enjoying my life.
Paul, United Kingdom
I have been a member of AA for 5 years and follow the 12-Step programme. To start with, it was just about learning to abstain from the alcohol addiction that was killing me but, in the longer term, following the programme has enabled me to have a whole new outlook on life, to deal with my underlying depression and to be happy with myself and my sobriety. My own experience is that it is not 'shame-based' at all but focuses very much on personal change and growth (as well as clearing away old damage to myself and others).
Laurence C, UK
Life coaching doesn't deserve to be in this group because unlike therapies, which presume you are broken and need to be fixed - or more normally to talk at expensive length about your problems - coaching moves people on by reinstating their belief that they can cope, and motivating them to do it. I'm not a coach but have benefited enough from coaching to have an opinion on this, it's turned my life around.
Pat, London UK
I worry that some counsellors hold on to clients as they pay their wages. Also by going over painful events over and over again some people fail to move on because they are held in that painful time. I think therapy has a place (I hope so as I am a counsellor) but would like to see different regulation perhaps under the NHS umbrella so that clients are not meal tickets for the unscrupulous. Regulation by other counsellors is not ideal, in my opinion, as they have a vested interest in increasing the workload
I have spent 13 years trying to 'get myself together' practising Buddhist meditation and living an ethical life as an ordained buddhist. However it is only through counselling that I have been able to address issues that experienced meditation practitioners could not help me with. There are good and bad counsellors - however find the person with the right skills and your life could change for the better.
As much as I may not think therapists can help I only turn to self harm and suicide when I give it up. If this is a dependence, then I'm thankful for it and I owe it my life.
I have found therapy to be a waste of time. Rather then me get dependent on therapy, when I quit after 12 months of wasted money and zero progress, the therapist pursued me, insisting that I continue. I think he was more dependent on me then I was on him. Well, dependent on my cheques at least.
I've spent about half my life in therapy due to depression and I agree that therapy can become not addictive but more a crutch you feel you can't live without. Even good therapists will agree this is likely to happen. However the therapy I have had has been life-saving and well worth the possibility of developing a dependence on therapy.
My daughter attended school 'counsellor' sessions - a dreadful period of time whereby an emotionally suspect person meddled with her mind. Frankly, it came to a head when the school stepped outside their mandate and it had to be stopped. When I questioned her on elements of her advice she claimed that she offered no advice 'simply wondered about things' - an interesting distinction that was probably wasted on a 13-year-old. Who polices the counsellor? Tread carefully down this route.
Patrick, Kent, UK
I did basic counselling training two years ago and one of the first things we learnt is to be aware of clients becoming dependant. The whole objective of counselling is to help your client cope with their life. Modern lifestyles have increased the pressure on individuals and families and many people need to understand why they behave or react in the way that they do. This can then assist them to amend their behaviour in a more positive way. A good counsellor does not enforce his will upon his clients - he merely makes them look at various aspects of their life, asks how and why this could be affecting their current day-to-day living and then asks how the client thinks he might go about making changes that will help to make his life better.
Donna Chisholm, Staffs, UK
It is only bad therapists who "write a script" for your life. The aim of therapy is to help you discover yourself and learn to help yourself. I am not a therapist, by the way.
As a psychotherapist, having worked for years as an alcohol counsellor, I really must emphasise the point that, in my opinion, 12-step groups do foster dependence, and although they do save lives and are incredibly supportive to those most in need, the philosophy is shame-based, and is not conducive to people moving on and getting on with their lives. 12-step programmes are NOT equivalent to counselling or therapy.
Dermod Moore, United Kingdom
It's obvious that people can get addicted to counselling - if something makes you feel better, you want to keep doing it. There are worse things for someone to be addicted to. People who have addictions will always be addicted to something - they may be addicted to a person, a relationship, a counsellor, gambling, food... but an addiction doesn't have to be harmful. It's sad that for many people counselling will fill a hole in their life and they will be addicted to it, but better that than alcohol or crime or self-harm.